Provider Demographics
NPI:1174554380
Name:HERR, LYNN RAE (PHD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:RAE
Last Name:HERR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:RAE
Other - Last Name:SENGBUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 121329
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-1329
Mailing Address - Country:US
Mailing Address - Phone:817-657-6876
Mailing Address - Fax:832-448-2801
Practice Address - Street 1:2712 HURSTVIEW DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2402
Practice Address - Country:US
Practice Address - Phone:888-365-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102760902Medicaid
TX680012256OtherRAILROAD
TX82888POtherBCBS